1

Neuropathic pain:
responds to Gabapentin. It should be gradually titrated so as to not cause over sedation. It is relatively inexpensive and has virtually no drug drug interactions. Lyrica (pregabalin) also works but is more expensive and has a ceiling of dose in women especially if kidney function is impaired from diabetes. There is a once a day form (Gralise) that can be used if taking medication 3 times a day is a problem.
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A complete nerve transection will leave an area totally numb. The distribution of the numbers depends upon where the nerve was cut. A partial nerve injury may leave the area tingly or incompletely numb. Finally even if the nerve is not cut the swelling and bruising to the tea can affect the nerve as well. Usually we consider sharp penetrating injuries as likely having nerve lacerations when sensation is lost. A hand surgeon can examine the hand and pinpoint the site or extent of nerve injury and recommend surgical repair if needed.
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2

Diabetic neuropathy:
Diabetic neuropathy has no known cure. Fortunately, there are treatments for diabetic neuropathy. The treatment mainly focuses on slowing progression of the disease, relieving pain, and restoring function.
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3

Get evaluated:
If the symptoms are due to neuropathy, topical capsaicin may be helpful for some, while others may benefit with oral medications. Watch you sugar intake, and have your vitamin b levels checked and supplemented as necessary. Consult with your physician for an appropriate plan of care.
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4

Take this home test::
Test each foot with the Ipswich test: Compared to the standard monofilament test, it was able to detect neuropathy("positive test") in 3 out of 4 patients. If the test is normal("negative") it's unlikely you have neuropathy.
Lightly touch the tips of 1st, 3rd & 5th toe for 1 second. Loss of sensation in two or more toes = neuropathy.
SEE: bit.ly/1vsGZXn
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5

Nerve Biopsy:
There are new test that help diagnosis the degree and severity of diabetic neuropathy. Epidermal nervefiber testing is a new way to test for neuropathy. Also having a emg/ncv (nerve flow test) perfomred will also assist in diagnosing neuropathy. A thorough clinical exam by your docotor will also help in diagnosisng your problem with tunning forks, and monofilament testing.
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6

Sensory, motor, Auto:
Sensory neuropathy is broken down into large fiber (loss of sensation, loss of proprioception) and small fiber (burning, tingling sensation). Most patient’s state the numbness starts at the tips of the toes and slowly works it way up the legs. Motor neuropathy causes gait instability and deformities of the feet. Lastly autonomic neuropathy effects include stomach emptying and erectile dysfunction.
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7

Pain, numbness. :
When diabetics have uncontrolled blood sugars their nerves pay the price over time. They can have tingling, burning, pain, a "tight" feeling, and numbness, and once it happens it's impossible to get normal sensation back. Some medications reduce the tingling, but nothing can reverse numbness.
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9

Individual variation:
Everyone is different. One diabetic can run blood sugars of 250 for 20 years and not get it, while another can run 150 for 5 years and get it. While average duration of diabetes before onset of diabetic neuropathy can be calculated for diabetics as a population, that doesn't predict the individual risk. But NEVER FORGET: The ONLY way to treat diabetic neuropathy is to treat the diabetes.
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10

Sexual function:
The first step is to see a urologist to determine if there is an organic cause for the inability to have an orgasm. Testosterone and PSA levels are often checked too. If there is no organic cause then psychological causes (e.g. marriage, divorce, sexual orientation) should be explored.
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When there is too much sugar floating around in the blood, the nerves get drunk on it and go foggy, mumbling their electrical impulses back to the brain, tingly, and aren't aware of stimulus trying to warn them their is stone in your shoe or that heating pad has been on too long and is burning your skin or you have an infection in your foot when you stubbed your toe, because the nerves are drunk.
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